Treatment Of Suicide Ideation By Focusing On Meaningful Purposeful Goals
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Treatment Of Suicide Ideation By Focusing On Meaningful Purposeful Goals

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    Treatment Of Suicide Ideation By Focusing On Meaningful Purposeful Goals Treatment Of Suicide Ideation By Focusing On Meaningful Purposeful Goals Document Transcript

    • Treatment of Recent Suicide Ideation Among Adolescents by a Program of Meaningful Purposeful Goals ABSTRACT This study examines the effects of a meaningful, purposeful goal intervention program on adolescents who have recently been identified with suicide ideation. Using participants from S.A.F.E. Intensive’s residential treatment center in Webster Groves, Missouri, we hope to find that adolescents participating in Making Goals for the Future will have fewer suicide attempts than those not in the intervention program. Throughout treatment we hope to see a significant decrease in current suicide ideationon participant’s scores on the Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS) and Beck Scale for Suicide Ideation (BSI) and an increase in meaning in life and purpose in life utilizing Purpose in Life test (PIL) and Life Purpose Questionnaire (LPQ). Siehs 1
    • INTRODUCTION According to the National Institute of Mental Health in 2010, suicide is one of the majorleading causes of deaths in youths between the ages of 10 and 24. Girls are more likely toattempt suicide, while boys are more likely to commit suicide through the most violent means(i.e., firearms). Suicide is extremely devastating to not only members of the family, but to one’speers and the community at large, making it an important public health problem in the UnitedStates. Adolescents who attempt suicide often report feeling trapped, lonely, worthless andhopeless about their lives and their future (Beck, Steer, Kovacs, & Garrison, 1985; Beck, Brown,& Steer, 1989;Beck et al., 1990;Kidd, 2004). Suicidal adolescents often lose a sense of purposeor meaning in life (Beck, Steer & Kumar, 1993) which makes suicide as a possible way out.Adolescents to attempt suicide once are at risk for attempting it again (Lewinsohn, Rohde, &Seeley, 1994).Statement of Problem The purpose of this study is to identifyadolescents who have expressed recent suicideideation and help them resolve this issue by participating in a meaningful, purposeful goaloriented program. Since having a reason for living and leading a meaningful life areincompatible with suicide, it is possible that realizing important personal goals might enhancehope and meaning in life, two protective factors against suicide.Review of the Literature Multiple studies in the 20th century (Beck, Steer, Kovacs, & Garrison, 1985; Beck,Brown, & Steer, 1989; Abramson et al., 1989; O’Connor & Cassidy, 2007; O’Connor & Sheely, Siehs 2
    • 2000; O’Connor, Connery & Cheyne, 2000) focus on identifying risk factors. These studies haveled to the development of various suicide prevention strategies such as help lines, earlyidentification and treatment of depression, crisis intervention, restriction of access to suicidemethods (such as gun control), access to and improvement of mental health services andtreatment, and educational programsfor health professionals (Lapierre, Dubé, Bouffard & Alain,2007; DeLeo &Scocco 2000; Jenkins & Singh, 2000). However, the effectiveness of thesesuicide prevention services is extremely limited (DeLeo, 2002; Lester, 2002; Hepp, Wittman,Schnyder & Michel, 2004).Risk Factors There is an abundance of research indicating that an individual’ssuicidal ideationisassociated with hopelessness (Brown, Beck, Steer, & Grismam, 2000; Abramson et al., 1989),a negative perception of one’s future (O’Connor & Cassidy, 2007; O’Connor & Sheely, 2000;O’Connor, Connery & Cheyne, 2000), and a lack of meaning in one’s life (Frankl, 1959 & 1985;Melton & Schulenberg, 2007). MacLeod’s 1997 study found a lack of positive future thinking isassociated with suicide risk. In other words, suicidal individuals are impaired at generatingpositive future expectancies. Williams (2001& 2005) Cry of Pain Model builds uponBaumeister’s 1990 study where it states that suicide is a response to entrapment rather than anescape. William’s Cry of Pain model took this further by stating ―suicidal behavior is reactive, aresponse to a stressful situation that has three components: defeat, no escape, no rescue‖(O’Connor, MacHale & Masterton, 2008). Frankl (1959 & 1985) theorizes that the most basic human motivator is a will to meaning.When will to meaning is interrupted, or blocked, existential frustration develops andconsequently boredom and apathy emerge. Frankl believes that life has meaning under all Siehs 3
    • circumstances, even when involved in intense and unavoidable suffering. With the opportunity,individuals can decide on an individual basis what is meaningful and, therefore, this enables theindividual to sustain suffering with dignity, rather than focusing on emptiness and hopelessness.Meaningful, Purposeful Goals Setting new goals and looking to the future can benefit an individual’s psychologicalwell-being and happiness (Lapierre, Dubé, Bouffard & Alain, 2007; Sheldon & Houser-Marko,2004; Brunstein, 1993). According to Snyder & Rand (2004) people who have hope believe thatthey can improve their situation, take responsibility for their own well-being and actively committhemselves to solving their problems. Additionally, past longitudinal studies have shown thatpersonal commitment in the pursuit of goals predicts psychological well-being (Sheldon &Houser-Marko, 2004 and Brunstein, 1993). In recent studies (Lapierre, Dubé, Bouffard & Alain, 2007 and Dubé et al., in press) foundthat a goal-intervention program could have a positive impact on participants’ psychologicalwell-being, enhance their quality of life, find meaning in their lives and actualize their potential,and, therefore, decrease their suicidality (Lapierre, Dubé, Bouffard & Alain, 2007; Edwards &Holden, 2001; Malone et al, 2000; Jobes & Mann, 1999). More specifically Lapierre, Dubé,Bouffard & Alain’s 2007 study used Dubé et al. (in press) goal preventionprogram on 154participants who were transitioning into retirement. Out of those 154 participants 27 had suicidalideation. Despite their small sample size, they found that the goal-intervention programincreasedthe participant’s psychological well-being and decreased depression in the participantswith suicidal ideation. Siehs 4
    • Statement of the Hypothesis Although the previous studies (Lapierre, Dubé, Bouffard & Alain, 2007 and Dubé et al.,in press) focused on retirees and was not offered to an entirely suicidal population, this researchteam speculates that this goal intervention program will be valuable to adolescent suicideprevention. Having a reason to live and leading a meaningful life have been found to beprotective factors when it comes to suicide ideation. An individual realizing an importantpersonal goal might enhance hope and meaning in life, as well as protect the individual fromfuture attempts on one’s own life. The present study will focus on youth who have expressedrecent suicide ideation. It is hypothesized that adolescents who have been identified with recentsuicide ideation and who participate in a purposeful, positive goal oriented therapy will exhibitsignificantly fewer suicide attempts than adolescent who are just being treated at a residentialfacility. METHODParticipantsParticipants will be recruited for this study from S.A.F.E. Intensives residential treatmentprogram. S.A.F.E. Intensives is located in Webster Groves, Missouri. S.A.F.E Intensivesspecifically focuses on the treatment of adolescents who engage in self-injurious behavior. Theparticipants will be between the ages of 12 to 21 years old and will be one of the 36 newlyadmitted clientele.The study chose this site especially because of its no medication policy, which focuses ontolerating distress, learning new coping skills as well as teaching the adolescents appropriateways to manage their feelings and providing them with a sense of mastery over their emotions. Siehs 5
    • Also, the site’s program lasts 10 to 12 weeks which is a perfect match for our goal-interventionprogram.Assessment InstrumentsBeck Depression Inventory (BDI-II)The BDI-II is a 21 item self-report questionnaire that assesses severity of depression. Thisinstrument is one of the most widelyused assessment measures in both research and clinicalsettings.Beck Hopelessness Scale (BHS)The BHS examines an individuals thoughts and beliefs about the future. This self-reportquestionnaire consists of 20 true-false items that measure 3 major aspects of hopelessness:feelings about the future, loss of motivation, and expectations. The hopelessness construct is afactor in many mental disorders and is highly correlated with measures of depression, suicidalintent, and ideation.Beck Scale for Suicide Ideation (BSI)The BSI is a 21-item self-report questionnaire that may be used to identify the presence andseverity of suicidal ideation. Items on this measure also assess the respondents suicidal plans,deterrents to suicide, and the level of openness to revealing suicidal thoughts.Purpose in Life test (PIL)Crumbaugh & Maholick in 1964 designed the PIL test operationalize Frankls ideas. The PIL isa 20-item self-report that may be used to quantify the respondent’s experience of meaning andpurpose in life. Each item is rated on a 7-point scale and total scores therefore range from 20(low purpose) to 140 (high purpose) Examples of the 20 items include: "I am usually: completelybored (1) — exuberant, enthusiastic (7)"; "As I view the world in relation to my life, the world:completely confuses me (1) — fits meaningfully with my life (7)," and "With regard to suicide, Ihave: thought of it seriously as a way out (1) — never given it a second thought (7)."Life Purpose Questionnaire (LPQ)The LPQ is a 20-item self-report with an agree/disagree responseinstrument designed tomeasure an individuals sense of life meaning. Although, Hablas & Hutzell made this self-reportto aid comprehension to their participants in their 1982, we will use this in addition to the PIL tomake sure there is internal validity and internal consistency in our study.Description of the Program Participants are given the opportunity to join a program called Making Goals for theFuture, which invites the participants to identify a meaningful, personal goal and pursue it Siehs 6
    • effectively. The participants are encouraged to learn how to manage their life goals in order toachieve enhanced and lasting well-being (Lapierre, Dubé, Bouffard & Alain, 2007). Based on a cognitive-behavioral approach and goal-intervention literature, the desiredtherapeutic changes are to increase the participant’s ability to identify and modify irrationalbeliefs that are detrimental to the goal-identification process, promote cognitive factors thatimprove regulation of goal-directed action, as well as increase the participant’s ability to viewalternative means to achieve a goal. In addition, another objective of the intervention is to createwarm, interpersonal relationships and mutual support among the participants. Duringadolescence peer support plays an important role in the teenager’s need for acceptance andpsychological well-being (Sullivan, 1953; Steinberg, 2008).Billie-Brahe & Jensen (2004) foundthat social support is a protective factor against suicide.Making Goals for the Future program will include 10 to 12 meetings of 2 hours each week of 3small groups of 6 participants each. Each group will be conducted by graduate counselingstudents who have been trained in the goal-intervention program. Appendix 1 presents the content and purpose of each step of the program: goal setting, goalplanning, goal pursuit and outcome evaluation, with an introductory meeting and a follow-upmeeting as well. During the program, each participant will be expected to identify, plan, pursueand realize one personal, concrete, meaningful, purposeful goal.Procedure The participants will be divided up randomly into 6 groups. Three groups with 6participants in each group will take part in the goal-intervention program; the other 3 groups with Siehs 7
    • 6 participants in each groupwill participate in S.A.F.E. Intensive program which involves group,individual, milieu and family therapy, impulse control management, case management, educationand support, as well as after-care planning.The study will include three measurement points: pretest, midtest and the post-test at the end ofthe intervention program, which will include a follow-up, 6 months later. During the preliminarymeeting (shown in Appendix 1) informed consent will be obtained and the participants will beprovided a brief description of the study. Also, the first assessment will be administered to theparticipants in order to obtain an initial, baseline score. The control group will also complete thequestionnaires at this time. The same action will take place during meetings 5 and then duringmeeting 11. The study will take 3 to 4 months to complete.Follow up meetings according toparticipant’s wishes can occur. Once follow up meeting are adjourned, the data will be collectedand analyzed. Siehs 8
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    • Steinberg, L.D. (2008). Adolescence. New York: McGraw-Hill.Sullivan, H.S. (1953). The interpersonal theory of psychiatry. New York: Norton.Williams, J.M.G. (2001). Suicide and Attempted Suicide. London, UK: Penguin.Williams, J.M.G., Crane, C., Barnhofer, T., Duggan, D. (2005). Psychology and suicidal behavior: Elaborating the entrapment. In K. Hawton (Ed.), Prevention and treatment of suicidal behavior: From science to practice. Oxford: Oxford University Press.Special Siehs 12